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Alcohol content in declared non-to low alcoholic beverages: implications to pregnancy.

https://arctichealth.org/en/permalink/ahliterature146266
Source
Can J Clin Pharmacol. 2010;17(1):e47-50
Publication Type
Article
Date
2010
Author
Y Ingrid Goh
Zulfikar Verjee
Gideon Koren
Author Affiliation
Motherisk Program, Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Canada.
Source
Can J Clin Pharmacol. 2010;17(1):e47-50
Date
2010
Language
English
Publication Type
Article
Keywords
Alcohol Drinking - adverse effects
Alcoholic Beverages - adverse effects - analysis
Beer - analysis
Beverages - analysis
Canada
Chromatography, Gas
Ethanol - adverse effects - analysis
Female
Food Labeling
Humans
Pregnancy
Pregnancy Complications - prevention & control
Wine - analysis
Abstract
Alcohol consumption in pregnancy may result in serious adverse fetal outcome. Non- or low alcoholic wines and beers may be a risk-reduction strategy to help alcohol-dependent individuals to prevent or limit ethanol consumption. The objective of this study was to quantify ethanol concentrations in Canadian beverages claiming to contain no or low alcohol content.
Forty-five different beverages claiming to contain no or low alcohol content in the Canadian market were tested for ethanol concentration using gas chromatography.
Thirteen (29%) of the beverages contained ethanol levels higher than the declared concentration on their label. Six beverages claiming to contain no alcohol were found to contain greater than 1% ethanol.
Pregnant women seeking replacement to alcoholic beverages may be misled by these labels, unknowingly exposing themselves and their unborn babies to ethanol.
PubMed ID
20051610 View in PubMed
Less detail

Alcohol use and pregnancy consensus clinical guidelines.

https://arctichealth.org/en/permalink/ahliterature138492
Source
J Obstet Gynaecol Can. 2010 Aug;32(8 Suppl 3):S1-31
Publication Type
Article
Date
Aug-2010
Author
George Carson
Lori Vitale Cox
Joan Crane
Pascal Croteau
Lisa Graves
Sandra Kluka
Gideon Koren
Marie-Jocelyne Martel
Deana Midmer
Irena Nulman
Nancy Poole
Vyta Senikas
Rebecca Wood
Society of Obstetricians and Gynaecologists of Canada
Source
J Obstet Gynaecol Can. 2010 Aug;32(8 Suppl 3):S1-31
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Alcohol Drinking - adverse effects - epidemiology
Alcoholic Beverages - analysis
Alcoholism - complications - diagnosis - therapy
Canada - epidemiology
Consensus
Counseling
Female
Fetal Alcohol Spectrum Disorders - etiology - prevention & control
Fetal Diseases - etiology - prevention & control
Humans
Mass Screening
Patient Education as Topic
Preconception Care
Pregnancy
Pregnancy Complications - diagnosis - therapy
Randomized Controlled Trials as Topic
Risk factors
Temperance
Abstract
to establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence.
published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.
the quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1).
the Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada.
these consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians of Canada; the Federation of Medical Women of Canada; the Society of Rural Physicians of Canada; and Motherisk. SUMMARY STATEMENTS: 1. There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III) 2. There is insufficient evidence to define any threshold for low-level drinking in pregnancy. (III) 3. Abstinence is the prudent choice for a woman who is or might become pregnant. (III) 4. Intensive culture-, gender-, and family-appropriate interventions need to be available and accessible for women with problematic drinking and/or alcohol dependence. (II-2).
1. Universal screening for alcohol consumption should be done periodically for all pregnant women and women of child-bearing age. Ideally, at-risk drinking could be identified before pregnancy, allowing for change. (II-2B) 2. Health care providers should create a safe environment for women to report alcohol consumption. (III-A) 3. The public should be informed that alcohol screening and support for women at risk is part of routine women's health care. (III-A) 4. Health care providers should be aware of the risk factors associated with alcohol use in women of reproductive age. (III-B) 5. Brief interventions are effective and should be provided by health care providers for women with at-risk drinking. (II-2B) 6. If a woman continues to use alcohol during pregnancy, harm reduction/treatment strategies should be encouraged. (II-2B) 7. Pregnant women should be given priority access to withdrawal management and treatment. (III-A) 8. Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy. (II-2A).
PubMed ID
21172102 View in PubMed
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Antiretroviral treatment of maternal HIV infection.

https://arctichealth.org/en/permalink/ahliterature179324
Source
Can Fam Physician. 2004 Jun;50:865-8
Publication Type
Article
Date
Jun-2004
Author
Haleh Talaie
Alejandro A Nava-Ocampo
Gideon Koren
Author Affiliation
Hospital for Sick Children, Toronto, Ont.
Source
Can Fam Physician. 2004 Jun;50:865-8
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Anti-HIV Agents - therapeutic use
Canada
Female
HIV Infections - drug therapy - prevention & control - transmission
HIV-1
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical - prevention & control
Pregnancy
Pregnancy Complications, Infectious - drug therapy - virology
Risk factors
Women's health
Abstract
One of my pregnant patients tested positive for human immunodeficiency virus. Will HIV therapy put her pregnancy outcome at risk?
The biggest risk is vertical transmission of HIV to her baby. She should be treated with combination therapy; triple therapy is required to reduce vertical transmission. Zidovudine is not teratogenic in humans, but information on other antiretroviral drugs is incomplete.
Notes
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PubMed ID
15233367 View in PubMed
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Are infants exposed to methadone in utero at an increased risk for mortality?

https://arctichealth.org/en/permalink/ahliterature124450
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e160-5
Publication Type
Article
Date
2012
Author
Lauren E Kelly
Michael J Rieder
Karen Bridgman-Acker
Albert Lauwers
Parvaz Madadi
Gideon Koren
Author Affiliation
The University of Western Ontario, Department of Physiology and Pharmacology, London, ON.
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e160-5
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Analgesics, Opioid - adverse effects
Cause of Death
Female
Humans
Infant
Infant mortality
Infant, Newborn
Male
Methadone - adverse effects
Neonatal Abstinence Syndrome - mortality
Odds Ratio
Ontario - epidemiology
Opiate Substitution Treatment - adverse effects
Opioid-Related Disorders - epidemiology - rehabilitation
Pregnancy
Prenatal Exposure Delayed Effects
Prevalence
Risk assessment
Risk factors
Time Factors
Young Adult
Abstract
The prevalence of opioid abuse is increasing in North America. Opioid abuse during pregnancy can cause medical, obstetric and psychosocial complications. Neonates exposed to opioids in utero often develop the neonatal abstinence syndrome. Methadone maintenance therapy is the treatment of choice for maternal opioid dependency. There have been unsupported concerns that infants cared for by mothers treated with methadone have higher mortality rates during the first year of life than in the general population.
To compare the mortality rates of infants exposed to methadone in utero to those of general population in Ontario, Canada.
We utilized several provincial and national databases including those of the Office of the Chief Coroner of Ontario, the Canadian Institute for Health Information, and the Ontario Infant Mortality Rate Report. Reference organ weights were obtained from the peer reviewed literature.
The Office of the Chief Coroner of Ontario has reported 8 deaths in children under one associated with in utero methadone exposure between January 1, 2006 and December 31, 2010. Over the same period there have been a total of 1103 cases of neonatal abstinence syndrome recorded in the province. The mean infant mortality rate in Ontario for children under the age of 1year over the same period was 5.2 per 1000 live births. The odds ratio for mortality among children with neonatal abstinence syndrome was not different from that in the general population [OR 1.45 (95% confidence interval 0.471-4.459)] (p=0.56).
The available data do not support the concerns that children under the age of one year, born to mothers on methadone maintenance therapy (MMT) are at an increased risk for mortality.
PubMed ID
22580362 View in PubMed
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Asking the right questions to ascertain early childhood secondhand smoke exposures.

https://arctichealth.org/en/permalink/ahliterature125299
Source
J Pediatr. 2012 Jun;160(6):1050-1
Publication Type
Article
Date
Jun-2012
Author
Jocelyn M Biagini Myers
Gurjit K Khurana Hershey
Ranjan Deka
Jeffrey W Burkle
Linda S Levin
David I Bernstein
Manuel Villareal
James E Lockey
Tiina Reponen
Joey Gareri
Angelika Lubetsky
Gideon Koren
Grace K Lemasters
Author Affiliation
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. jocelyn.biagini.myers@cchmc.org
Source
J Pediatr. 2012 Jun;160(6):1050-1
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Child, Preschool
Cotinine - analysis
Female
Follow-Up Studies
Humans
Incidence
Infant
Infant, Newborn
Male
Ontario - epidemiology
Pregnancy
Prenatal Exposure Delayed Effects - chemically induced - epidemiology - metabolism
Prognosis
Questionnaires - standards
Radioimmunoassay
Socioeconomic Factors
Time Factors
Tobacco Smoke Pollution - adverse effects
Abstract
Secondhand smoke is associated with a myriad of adverse health outcomes. Therefore, it is essential for clinicians to ask precise questions about exposures, particularly for children. We present 4 questions that incorporate several locations of exposure and provide a more comprehensive account of children's smoke exposures than maternal smoking alone.
Notes
Cites: JAMA. 1994 Feb 23;271(8):621-38301796
Cites: J Pediatr Health Care. 2011 Nov-Dec;25(6):365-7222018427
Cites: J Pediatr. 2006 Oct;149(4):505-1117011322
PubMed ID
22494871 View in PubMed
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Behavioural effects of fetal antidepressant exposure in a Norwegian cohort of discordant siblings.

https://arctichealth.org/en/permalink/ahliterature274869
Source
Int J Epidemiol. 2015 Aug;44(4):1397-407
Publication Type
Article
Date
Aug-2015
Author
Ragnhild Eek Brandlistuen
Eivind Ystrom
Malin Eberhard-Gran
Irena Nulman
Gideon Koren
Hedvig Nordeng
Source
Int J Epidemiol. 2015 Aug;44(4):1397-407
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - adverse effects
Child Behavior Disorders - etiology
Child Development - drug effects
Child, Preschool
Cohort Studies
Depression - drug therapy
Female
Humans
Infant
Male
Maternal Exposure - adverse effects
Mothers - psychology
Norway
Pregnancy
Pregnancy Complications - drug therapy
Prenatal Exposure Delayed Effects - psychology
Risk factors
Siblings - psychology
Surveys and Questionnaires
Abstract
Potential adverse effects of prenatal antidepressant exposure on child development are still debated. The possibility that associations are due to genetic or familial environmental risk factors rather than antidepressant use per se cannot easily be ruled out in conventional studies. Our objective was therefore to evaluate the association between prenatal antidepressant exposure and behavioural problems in a sibling controlled study.
This study used data on 20?180 siblings identified from the population-based Norwegian Mother and Child Cohort Study recruited between 1999 and 2008. The mothers were asked to report antidepressant use at gestational weeks 17 and 30 and 6 months post-partum. Child Behavioral Checklist syndrome scales were used to assess externalizing and internalizing behavioural problems by questionnaires sent to mothers at 18 and 36 months postpartum. We performed unmatched and matched sibling analyses using both random- and fixed-effects linear models, respectively, to determine potential behavioural effects of antidepressant exposure.
Prenatal exposure to antidepressants was associated with increased levels of anxiety symptoms in 3 year old children after adjusting for maternal familial effects and confounding by indication (i.e. maternal depression). Effect of prenatal exposure to antidepressants was specific to anxiety, and not associated with emotional reactivity, somatic complaints, sleep problems, attention problems or aggression.
Using a sibling design, we showed that prenatal antidepressant use was specifically associated with increased anxiety symptoms after adjusting for maternal familial factors and confounding by indication.
Notes
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PubMed ID
25873178 View in PubMed
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Breakthrough in treating gestational diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature178782
Source
Can Fam Physician. 2004 Jul;50:987, 989
Publication Type
Article
Date
Jul-2004
Author
Gideon Koren
Source
Can Fam Physician. 2004 Jul;50:987, 989
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adult
Diabetes, Gestational - drug therapy
Female
Glyburide - administration & dosage - pharmacokinetics - therapeutic use
Humans
Hypoglycemic Agents - administration & dosage - pharmacokinetics - therapeutic use
Insulin - therapeutic use
Manitoba
Patient compliance
Pregnancy
Rural Health Services
Abstract
I practise in a remote community in Manitoba. Quite a few of my patients experience gestational diabetes. Their compliance with the insulin regimen is abysmal. Can I give them an oral medication?
Recent studies have indicated that glyburide does not cross the human placenta and that its effectiveness and safety profiles are similar to those of insulin.
Notes
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PubMed ID
15317230 View in PubMed
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The burden of prenatal exposure to alcohol: revised measurement of cost.

https://arctichealth.org/en/permalink/ahliterature152976
Source
Can J Clin Pharmacol. 2009;16(1):e91-102
Publication Type
Article
Date
2009
Author
Brenda Stade
Alaa Ali
Dainel Bennett
Douglas Campbell
Mary Johnston
Cynthia Lens
Sofia Tran
Gideon Koren
Author Affiliation
Department of Paediatrics, St Michael's Hospital, Toronto, Canada. stadeb@smh.toronto.on.ca
Source
Can J Clin Pharmacol. 2009;16(1):e91-102
Date
2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada - epidemiology
Child
Child, Preschool
Costs and Cost Analysis
Cross-Sectional Studies
Female
Fetal Alcohol Spectrum Disorders - economics - epidemiology
Health Care Costs - statistics & numerical data
Health Resources - utilization
Health Services Needs and Demand - economics
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Pregnancy
Prospective Studies
Sickness Impact Profile
Young Adult
Abstract
In Canada the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. FASD is the leading cause of developmental and cognitive disabilities in Canada. Only one study has examined the cost of FASD in Canada. In that study we did not include prospective data for infants under the age of one year, costs for adults beyond 21 years or costs for individuals living in institutions.
To calculate a revised estimate of direct and indirect costs associated with FASD at the patient level.
Cross-sectional study design was used. Two-hundred and fifty (250) participants completed the study tool. Participants included caregivers of children, youth and adults, with FASD, from day of birth to 53 years, living in urban and rural communities throughout Canada participated. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs: medical, education, social services, out-of-pocket costs; and indirect costs: productivity losses. Total average costs per individual with FASD were calculated by summing the costs for each in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A stepwise multiple regression analysis was used to identify significant determinants of costs and to calculate the adjusted annual costs associated with FASD.
Total adjusted annual costs associated with FASD at the individual level was $21,642 (95% CI, $19,842; $24,041), compared to $14,342 (95% CI, $12,986; $15,698) in the first study. Severity of the individual's condition, age, and relationship of the individual to the caregiver (biological, adoptive, foster) were significant determinants of costs (p
PubMed ID
19168935 View in PubMed
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The Canadian Pharmacogenomics Network for Drug Safety: a model for safety pharmacology.

https://arctichealth.org/en/permalink/ahliterature142605
Source
Thyroid. 2010 Jul;20(7):681-7
Publication Type
Article
Date
Jul-2010
Author
Colin J D Ross
Henk Visscher
Johanna Sistonen
Liam R Brunham
Kusala Pussegoda
Tenneille T Loo
Michael J Rieder
Gideon Koren
Bruce C Carleton
Michael R Hayden
Author Affiliation
Department of Medical Genetics, Faculty of Medicine, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada.
Source
Thyroid. 2010 Jul;20(7):681-7
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Adverse Drug Reaction Reporting Systems
Antithyroid Agents - adverse effects
Biomarkers, Pharmacological
Canada - epidemiology
Child
Cisplatin - adverse effects
Codeine - poisoning
Drug-Related Side Effects and Adverse Reactions - epidemiology - genetics - mortality - prevention & control
Genetic Association Studies
Genetic markers
Genetic Testing - methods
Humans
Individualized Medicine - methods
International Cooperation
Pharmacogenetics - methods
Population Surveillance - methods
Sentinel Surveillance
Abstract
Adverse drug reactions (ADRs) rank as one of the top 10 leading causes of death in the developed world, and the direct medical costs of ADRs exceed $100 billion annually in the United States alone. Pharmacogenomics research seeks to identify genetic factors that are responsible for individual differences in drug efficacy and susceptibility to ADRs. This has led to several genetic tests that are currently being used to provide clinical recommendations. The Canadian Pharmacogenomics Network for Drug Safety is a nation-wide effort established in Canada to identify novel predictive genomic markers of severe ADRs in children and adults. A surveillance network has been established in 17 of Canada's major hospitals to identify patients experiencing specific ADRs and to collect biological samples and relevant clinical history for genetic association studies. To identify ADR-associated genetic markers that could be incorporated into predictive tests that will reduce the occurrence of serious ADRs, high-throughput genomic analyses are conducted with samples from patients that have suffered serious ADRs and matched control patients.
ADRs represent a significant unmet medical problem with significant morbidity and mortality, and Canadian Pharmacogenomics Network for Drug Safety is a nation-wide network in Canada that seeks to identify genetic factors responsible for interindividual differences in susceptibility to serious ADRs.
Active ADR surveillance is necessary to identify and recruit patients who suffer from serious ADRs. National and international collaborations are required to recruit sufficient patients for these studies. Several pharmacogenomics tests are currently in clinical use to provide dosing recommendations, and the number of pharmacogenomics tests is expected to significantly increase in the future.
PubMed ID
20578893 View in PubMed
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Cancer in pregnancy: Motherisk on-line question and answer forum.

https://arctichealth.org/en/permalink/ahliterature160346
Source
Can Fam Physician. 2007 Nov;53(11):1891-2
Publication Type
Article
Date
Nov-2007
Author
Sandy Grupp
Adrienne Einarson
Gideon Koren
Source
Can Fam Physician. 2007 Nov;53(11):1891-2
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adult
Antineoplastic Combined Chemotherapy Protocols - adverse effects - therapeutic use
Canada
Family Practice - methods
Female
Fetal Development - drug effects
Gestational Age
Humans
Maternal Health Services - methods
Patient Education as Topic - methods
Pregnancy
Pregnancy Complications, Neoplastic - diagnosis - drug therapy
Pregnancy outcome
Prenatal Diagnosis
Questionnaires
Risk assessment
Women's health
Abstract
It seems to me that cancer is occurring or being diagnosed more frequently among young women who are or might become pregnant. In the past year, I have seen several such women in my practice and I have had difficulty finding appropriate information in order to counsel them. Is there somewhere I can go for information about cancer during pregnancy so that I can better educate and inform these patients?
The Motherisk Program at the Hospital for Sick Children supports an on-line Cancer in Pregnancy Forum where physicians and other health care professionals can submit questions or details of experiences that they have had with patients who had cancer during pregnancy. Questions about the safety of chemotherapeutic drugs before and during pregnancy and about possible exacerbation of previous cancer by pregnancy are most common.
Notes
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Cites: Med Pediatr Oncol. 1988;16(1):3-63340063
PubMed ID
18000262 View in PubMed
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92 records – page 1 of 10.